Percutaneous method, e.g. biopsies or punctures play an important role in the diagnosis and treatment of various diseases. The principle of a percutaneous intervention is based on the puncturing of a pathological process, for example a tumor in the liver, through the skin. In this process tissue samples can be taken for diagnostic purposes for example using special biopsy needles. Percutaneous interventions also allow a therapy, for example the TIPSS procedure (TIPSS: transcutaneous intrahepatic porto-systemic shunt), the drainage of an abscess or the thermoablation of a solitary liver metastasis, to be carried out. A percutaneous puncture generally takes place after prior imaging diagnosis using computed tomography (CT), magnetic resonance tomography (MRT) or ultrasound and is monitored and controlled during the interventions by means of real-time imaging.
Because they are minimally invasive, use reliable access paths and allow local therapy, percutaneous interventions will be carried out with increasing frequency in coming years. Improved diagnosis allows potential pathologies to be discovered at increasingly early stages and increasingly small disease centers to be punctured in positions that are difficult to access. Nevertheless percutaneous diagnosis and therapy still have some limitations. The literature indicates a complication rate between 3.9% and 23.9%. These are predominantly non-life-threatening bleeding, hematomas, pneumothoraces or organ damage. However there is still a risk of dying from such an intervention, in particular if a major vessel has been damaged accidentally. Puncture error is a further serious problem. The rate of incorrect or incomplete punctures is given as up to 30% in the literature. Puncture errors can result in false negative diagnoses or an inadequate therapeutic dosage in the required target region. The number of incorrect punctures must therefore be kept as low as possible both in the interests of the patient and from the point of view of effective and economical medicine.
The problem with a precise puncture lies in the variability of the target region due to respiratory movement, displacement and deformation of organs and the disease center due to the advance of the needle and possible unpredictable patient movement.
DE 10 2005 032 755 A1 therefore describes a system for carrying out and monitoring minimally invasive interventions, wherein 2D x-ray images of an object region are recorded at different projection angles using a C-arm x-ray system and 3D image data of the object region is reconstructed from the 2D x-ray recordings. The same x-ray system can then be used during the intervention to record 2D images in real time and to overlay them on the display of the 3D image data. This system can also be used to carry out 3D ultrasound recordings in real time using an ultrasound catheter and to register and display said recordings with the high-resolution 3D image data of the C-arm x-ray device.
However with the last-mentioned method either the deposition of ionizing radiation during the intervention must be taken into account for the patient or the application is limited to certain regions in the case of the ultrasound catheter. In particular biopsies and punctures can generally not be carried out using an ultrasound catheter.